Healthcare Provider Details

I. General information

NPI: 1629270665
Provider Name (Legal Business Name): TYLER K VANHOLLEBEKE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 4TH AVE STE 1000
SEATTLE WA
98161-1017
US

IV. Provider business mailing address

616 2ND AVE
SEATTLE WA
98104-2204
US

V. Phone/Fax

Practice location:
  • Phone: 206-622-9001
  • Fax: 206-622-4311
Mailing address:
  • Phone: 206-467-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: